Editorial: Therapists in dentistry a useful idea

The suggestion that dental nurses should be able to provide at least some of the services reserved to dentists is to be welcomed. There would need to be some safety regulations, of course, as there are for all health services. But the principle that people should have a wider choice of dental services ought to be the dominant consideration by the Dental Council, which is defining the nurses' "scope of practice" in accordance with legislation passed last year. The legislation opens the way for dental therapists, as the nurses now are known, to set up in private practice. That is the wish of the council's dental therapists' board, too.

A consultation document issued by the council suggests that therapists in independent practice could provide basic care for children and adolescents. It suggests they could treat adults but only in a "team situation with a named dentist". That seems unduly restrictive. Dental therapists are not qualified to perform all the work of a dentist but they can provide a great deal of the basic, regular and preventive attention that everyone needs. More important, they would probably be able to offer such a service at a lower cost than dentists generally charge. That would be particularly valuable for lower-income earners who struggle to afford the hundreds of dollars it can cost for even a routine visit to a dentist.

Dentists will object that lower costs mean a lower standard of service. And those who always presume to speak for the less well-off will complain that nobody should have to settle for second-class health treatment. But that sort of rhetoric obscures the fact that people often choose a lesser standard of health treatment, especially in dental care. It is common for dentists to present a patient with a range of solutions to a dental problem, and the relative costs of each proposal are an important element in the patient's choice.

The advent of dental therapists in private practice would extend that choice to basic care. And if those who chose it were opting for a lesser standard of service, it needs to be remembered that right now they are probably opting for none. Many adults unable to afford dental fees neglect that side of their health. A lower standard of attention, at lower cost, is immensely preferable to none.

But would the standard be lower? The answer, for many, will be conditioned by unpleasant memories of school dental clinics in an era before fluoridation of drinking water. Therapists who wished to provide a service that was competitive with dentists' could not afford to drill and fill excessively. They would need, further, to reassure their patients that they would not exceed their expertise, that they would readily refer more complicated work to a dentist. But that is common practice in health services and there is no reason to think dental therapists would be any less professional.

Dentists seem to believe that they would be called on to repair therapists' mistakes, for they want therapists to continue to be allowed to practise only under a dentist's supervision. But if dentists were to embrace the idea of therapists providing lower-cost dental care, and readily accepted referrals from them, dentists, too, could be better off. They would easily retain clients who could afford a first-class service, and attend also to referred patients who might never have had dental attention were it not for the advent of independent therapist practices.

A lower-cost service also increases the practicality of state-funded dental treatment. The cost of dental attention for everyone at dentists' rates is too fearful to contemplate. But a therapist's attention might be more affordable, as might referrals to a dentist for those of limited means. Liberalisation of dentistry would open all sorts of possibilities and fill many a gap.